<?xml version="1.0" encoding="UTF-8"?>

<div xmlns="http://www.w3.org/1999/xhtml" component="$model/UI2/system/components/justep/window/window" xid="window" design="device:mobile" data-bind="component:{name:'$model/UI2/system/components/justep/window/window'}" __justepbasexid__="__baseID__" components="$model/UI2/system/components/justep/windowReceiver/windowReceiver,$model/UI2/system/components/justep/panel/panel,$model/UI2/system/components/justep/panel/child,$model/UI2/system/components/justep/model/model,$model/UI2/system/components/justep/window/window,$model/UI2/system/components/justep/titleBar/titleBar,$model/UI2/system/components/justep/data/data,$model/UI2/system/components/justep/button/button,$model/UI2/system/components/justep/input/input,">  
  <div xmlns="" component="$model/UI2/system/components/justep/model/model" xid="model" style="display:none" data-bind="component:{name:'$model/UI2/system/components/justep/model/model'}"/>  
  <span xmlns="" component="$model/UI2/system/components/justep/windowReceiver/windowReceiver" xid="windowReceiver" style="left:94px;top:30px;" data-bind="component:{name:'$model/UI2/system/components/justep/windowReceiver/windowReceiver'}"/>  
  <span xmlns="" component="$model/UI2/system/components/justep/windowReceiver/windowReceiver" xid="windowReceiver1" style="left:215px;top:17px;" data-bind="component:{name:'$model/UI2/system/components/justep/windowReceiver/windowReceiver'}"/>  
  <div xmlns="" component="$model/UI2/system/components/justep/panel/panel" class="x-panel x-full pe400f21349bd4acf8e7f17c5d49ad630-iosstatusbar" data-bind="component:{name:'$model/UI2/system/components/justep/panel/panel'}"> 
    <div class="x-panel-top" component="$model/UI2/system/components/justep/panel/child" data-bind="component:{name:'$model/UI2/system/components/justep/panel/child'}"> 
      <div component="$model/UI2/system/components/justep/titleBar/titleBar" class="x-titlebar" data-bind="component:{name:'$model/UI2/system/components/justep/titleBar/titleBar'}"> 
        <div class="x-titlebar-left x-titlebar-title"> 
          <a component="$model/UI2/system/components/justep/button/button" class="btn btn-link btn-only-icon" xid="backBtn" data-bind="component:{name:'$model/UI2/system/components/justep/button/button'}" data-events="onClick:backBtnClick" data-config="{&quot;icon&quot;:&quot;icon-chevron-left&quot;,&quot;label&quot;:&quot;&quot;}"> 
            <i class="icon-chevron-left"/> 报修填报
          </a>  
          <div class="x-titlebar-right"> 
            <a component="$model/UI2/system/components/justep/button/button" class="btn btn-default btn-only-icon" xid="button3" style="background:none;border:none;float:right;margin-right:10px;" data-bind="component:{name:'$model/UI2/system/components/justep/button/button'}" data-config="{&quot;icon&quot;:&quot;icon-android-checkmark&quot;,&quot;label&quot;:&quot;button&quot;}"> 
              <i xid="i3" class="icon-android-checkmark"/> 
            </a> 
          </div> 
        </div> 
      </div> 
    </div>  
    <div class="x-panel-content" component="$model/UI2/system/components/justep/panel/child" data-bind="component:{name:'$model/UI2/system/components/justep/panel/child'}"> 
      <form style="margin-top:20px;padding:0 10px 0 10px;"> 
        <div class="form-group"> 
          <label style="color:red">*</label>  
          <label>姓名</label>  
          <input type="text" class="form-control" id="name" placeholder="请输入姓名"/> 
        </div>  
        <div class="form-group"> 
          <label style="color:red">*</label>  
          <label>联系电话</label>  
          <input type="text" class="form-control" id="phone" placeholder="请输入联系电话"/> 
        </div>  
        <div class="form-group"> 
          <label style="color:red">*</label>  
          <label>选择产品</label>  
          <select class="form-control" placeholder="请选择产品" id="produce"> 
            <option/>  
            <option>产品A</option>  
            <option>产品B</option>  
            <option>产品C</option>  
            <option>产品D</option>  
            <option>产品E</option> 
          </select> 
        </div>  
        <div class="form-group"> 
          <label style="color:red">*</label>  
          <label>回复时段</label>  
          <input component="$model/UI2/system/components/justep/input/input" class="form-control" xid="datetime" data-bind="component:{name:'$model/UI2/system/components/justep/input/input'}" data-config="{&quot;dataType&quot;:&quot;DateTime&quot;,&quot;placeHolder&quot;:&quot;请选择回复时段&quot;}"/> 
        </div>  
        <div class="form-group"> 
          <label style="color:red">*</label>  
          <label>故障类型</label>  
          <select class="form-control" xid="input1" placeHolder="请选择故障类型" id=""> 
            <option>类型1</option>  
            <option>类型2</option>  
            <option>类型3</option>  
            <option>类型4</option> 
          </select> 
        </div> 
      </form> 
    </div>  
    <style>.x-panel.pe400f21349bd4acf8e7f17c5d49ad630-iosstatusbar &gt;.x-panel-top {height: 48px;}.x-panel.pe400f21349bd4acf8e7f17c5d49ad630-iosstatusbar &gt;.x-panel-content { top: 48px;bottom: nullpx;}.x-panel.pe400f21349bd4acf8e7f17c5d49ad630-iosstatusbar &gt;.x-panel-bottom {height: nullpx;}.iosstatusbar .x-panel.pe400f21349bd4acf8e7f17c5d49ad630-iosstatusbar &gt;.x-panel-top {height: 68px;}.iosstatusbar .x-panel.pe400f21349bd4acf8e7f17c5d49ad630-iosstatusbar &gt;.x-panel-content { top: 68px;}.iosstatusbar .x-panel .x-panel-content .x-panel.pe400f21349bd4acf8e7f17c5d49ad630-iosstatusbar &gt;.x-panel-top {height: 48px;}.iosstatusbar .x-panel .x-panel-content .x-panel.pe400f21349bd4acf8e7f17c5d49ad630-iosstatusbar &gt;.x-panel-content {top: 48px;}</style> 
  </div> 
</div>
